纳米刀消融治疗局部进展期胰腺癌的免疫机制研究  

Reserch on immune mechanism of Nanoknife ablation for locally advanced pancreatic cancer

作　　者：陈艳军[1] 程冰冰[1] 郜宇[1] 陈升阳[1] 胡水全 李晓勇[1] CHEN Yan-jun;CHENG Bing-bing;GAO Yu;CHEN Sheng-yang;HU Shui-quan;LI Xiao-yong(The Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第五附属医院肝胆胰外科,郑州450052

出　　处：《医药论坛杂志》2021年第4期1-6,11,共7页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(2018020258)。

摘　　要：目的探讨纳米刀消融治疗局部进展期胰腺癌中的免疫机制。方法回顾性分析纳米刀消融治疗的13例局部进展期胰腺癌患者的临床资料及相关免疫指标。结果(1)肿瘤标志物CA19-9术后第1 d显著升高,此后逐渐下降;(2)CD3^(+)T细胞于术后第1 d下降,此后逐渐上升,于术后第7 d超过术前水平并继续保持上升趋势,术后第30 d测定值显著高于术前水平(P<0.05)。CD3^(+)CD4^(+)T细胞于术后第1 d下降,术后第3 d开始逐渐升高,并于术后第7 d达高峰,此后呈逐渐下降趋势,但始终高于术前水平;CD3^(+)CD8^(+)T细胞术后第1 d明显升高,此后逐渐下降,术后第3 d降至术前水平以下并于术后第7 d达最低值,此后趋势反转开始逐渐升高,术后第14 d超过术前水平并继续升高;(3)CD3-CD19^(+)B细胞术后第1 d开始升高,第3 d达高峰,此后逐渐下降,IgA、IgG、IgM的变化趋势与CD3-CD19^(+)B细胞相反,而IgE的变化趋势与CD3-CD19^(+)B细胞相同。结论纳米刀消融后,肿瘤相关的免疫抑制被解除,由CD4^(+)T细胞辅助、IgE介导的抗肿瘤作用显著加强,IRE术后的14 d内为免疫治疗的窗口期。Objective To investigate the immune mechanism in the treatment of locally advanced pancreatic cancer by nanoscale ablation.Methods The clinical data and related immune indexes of 13 patients with locally advanced pancreatic cancer treated by nanoscale ablation were retrospectively analyzed.Results(1)The tumor marker CA19-9 increased significantly on the first day after surgery and gradually decreased thereafter;(2)CD3^(+)T cells decreased on the 1 st day after surgery,and gradually increased thereafter.On the 7 th day after surgery,CD3^(+)T cells exceeded the preoperative level and continued to increase.The measured value on the 30 th day after surgery was significantly higher than the preoperative level(P<0.05).CD3^(+)CD4^(+)T cells decreased on the 1 st day after surgery,gradually increased on the 3 rd day after surgery,and reached a peak on the 7 th day after surgery.Since then,they showed a gradual downward trend,but were always higher than the preoperative level.CD3^(+)CD8^(+)T cells significantly increased on the first day after surgery,and gradually decreased thereafter.On the third day after surgery,CD3^(+)CD8^(+)T cells decreased to below the preoperative level and reached the lowest value on the seventh day after surgery.After that,the trend reversal began to increase gradually,and exceeded the preoperative level and continued to increase on the 14 th day after surgery.(3)CD3-CD19^(+)B cells began to increase on the 1 st day after surgery,and reached a peak on the 3 rd day,and gradually decreased thereafter.The change trend of IgA,IgG and IgM was opposite to that of CD3-CD19^(+)B cells,while that of IgE was the same as that of CD3-CD19^(+)B cells.Conclusion Tumor-related immunosuppression was relieved after the nanoknife ablation,and the anti-tumor effect mediated by CD4^(+)T cells was significantly enhanced.The window period of immunotherapy was 14 days after the IRE operation.

关 键 词：局部进展期胰腺癌 纳米刀消融 免疫机制 

分 类 号：R735.9[医药卫生—肿瘤]